Provider Demographics
NPI:1104129246
Name:NAST-GOLAS, KELLYANN (RN,BSN)
Entity type:Individual
Prefix:MRS
First Name:KELLYANN
Middle Name:
Last Name:NAST-GOLAS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 MINERVA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4102
Mailing Address - Country:US
Mailing Address - Phone:215-482-4603
Mailing Address - Fax:
Practice Address - Street 1:101 N MERION AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2859
Practice Address - Country:US
Practice Address - Phone:610-526-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN528155L163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health